Echocardiographic predictors of thrombus in left atrial appendage-The role of novel transthoracic parameters

Damian Kaufmann; Elżbieta Wabich; Agnieszka Kapłon-Cieślicka; Monika Gawałko; Monika Budnik; Beata Uziębło-Życzkowska; Paweł Krzesiński; Katarzyna Starzyk; Beata Wożakowska-Kapłon; Maciej Wójcik; Robert Błaszczyk; Jarosław Hiczkiewicz; Jan Budzianowski; Katarzyna Mizia-Stec; Maciej T Wybraniec; Katarzyna Kosmalska; Marcin Fijałkowski; Anna Szymańska; Mirosław Dłużniewski; Maciej Haberka; Michał Kucio; Błażej Michalski; Karolina Kupczyńska; Anna Tomaszuk-Kazberuk; Katarzyna Wilk-Śledziewska; Renata Wachnicka-Truty; Marek Koziński; Paweł Burchardt; Ludmiła Daniłowicz-Szymanowicz

doi:10.3389/fcvm.2022.1059111

Echocardiographic predictors of thrombus in left atrial appendage-The role of novel transthoracic parameters

Front Cardiovasc Med. 2022 Nov 30:9:1059111. doi: 10.3389/fcvm.2022.1059111. eCollection 2022.

Authors

Damian Kaufmann¹, Elżbieta Wabich¹, Agnieszka Kapłon-Cieślicka^{2

3}, Monika Gawałko^{2

3

4

5}, Monika Budnik^{2

3}, Beata Uziębło-Życzkowska⁶, Paweł Krzesiński^{2

6}, Katarzyna Starzyk⁷, Beata Wożakowska-Kapłon⁷, Maciej Wójcik⁸, Robert Błaszczyk⁸, Jarosław Hiczkiewicz^{9

10}, Jan Budzianowski^{9

10}, Katarzyna Mizia-Stec^{2

11}, Maciej T Wybraniec^{2

11}, Katarzyna Kosmalska¹², Marcin Fijałkowski^{2

13}, Anna Szymańska^{2

14}, Mirosław Dłużniewski¹⁴, Maciej Haberka^{2

15}, Michał Kucio¹⁵, Błażej Michalski^{2

16}, Karolina Kupczyńska^{2

16}, Anna Tomaszuk-Kazberuk^{2

17}, Katarzyna Wilk-Śledziewska^{2

17}, Renata Wachnicka-Truty¹⁸, Marek Koziński^{2

18}, Paweł Burchardt^{2

19}, Ludmiła Daniłowicz-Szymanowicz¹

Affiliations

¹ Department of Cardiology and Electrotherapy, Medical University of Gdańsk, Gdańsk, Poland.
² "Club 30," Polish Cardiac Society, Warsaw, Poland.
³ 1st Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland.
⁴ West German Heart and Vascular Centre, Institute of Pharmacology, University of Duisburg-Essen, Essen, Germany.
⁵ Department of Cardiology, Maastricht University Medical Centre, Cardiovascular Research Institute Maastricht, Maastricht, Netherlands.
⁶ Department of Cardiology and Internal Diseases, Military Institute of Medicine, Warsaw, Poland.
⁷ 1st Clinic of Cardiology and Electrotherapy, Świętokrzyskie Cardiology Centre, Collegium Medicum Jan Kochanowski University, Kielce, Poland.
⁸ Department of Cardiology, Medical University of Lublin, Lublin, Poland.
⁹ Clinical Department of Cardiology, Nowa Sól Multidisciplinary Hospital, Nowa Sól, Poland.
¹⁰ Collegium Medicum, Department of Interventional Cardiology and Cardiac Surgery, University of Zielona Góra, Zielona Góra, Poland.
¹¹ 1st Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland.
¹² Department of Cardiology, St. Vincent Hospital, Gdynia, Poland.
¹³ 1st Department of Cardiology, Medical University of Gdańsk, Gdańsk, Poland.
¹⁴ Department of Heart Diseases, Postgraduate Medical School, Katowice, Poland.
¹⁵ Department of Cardiology, School of Health Sciences, Medical University of Silesia, Katowice, Poland.
¹⁶ Department of Cardiology, Medical University of Łódź, Łódź, Poland.
¹⁷ Department of Cardiology, Medical University of Białystok, Białystok, Poland.
¹⁸ Department of Cardiology and Internal Medicine, Medical University of Gdańsk, Gdańsk, Poland.
¹⁹ Department of Hypertension, Angiology, and Internal Medicine, Poznan University of Medical Sciences, Poznań, Poland.

Abstract

Introduction: The left atrium appendage thrombus (LAAT) formation is a complex process. A CHA₂DS₂-VASc scale is an established tool for determining the thromboembolic risk and initiation of anticoagulation treatment in patients with atrial fibrillation or flutter (AF/AFL). We aimed to identify whether any transthoracic echocardiography (TTE) parameters could have an additional impact on LAAT detection.

Methods: That is a sub-study of multicenter, prospective, observational study LATTEE (NCT03591627), which enrolled 3,109 consecutive patients with AF/AFL referred for transesophageal echocardiography (TEE) before cardioversion or ablation.

Results: LAAT was diagnosed in 8.0% of patients. The univariate logistic regression analysis [based on pre-specified in the receiver operating characteristic (ROC) analysis cut-off values with AUC ≥ 0.7] identified left ventricular ejection fraction (LVEF) ≤ 48% and novel TTE parameters i.e., the ratios of LVEF and left atrial diameter (LAD) ≤ 1.1 (AUC 0.75; OR 5.64; 95% CI 4.03-7.9; p < 0.001), LVEF to left atrial area (LAA) ≤ 1.7 (AUC 0.75; OR 5.64; 95% CI 4.02-7.9; p < 0.001), and LVEF to indexed left atrial volume (LAVI) ≤ 1.1 (AUC 0.75, OR 6.77; 95% CI 4.25-10.8; p < 0.001) as significant predictors of LAAT. In a multivariate logistic regression analysis, LVEF/LAVI and LVEF/LAA maintained statistical significance. Calculating the accuracy of the abovementioned ratios according to the CHA₂DS₂-VASc scale values revealed their highest predictive power for LAAT in a setting with low thromboembolic risk.

Conclusion: Novel TTE indices could help identify patients with increased probability of the LAAT, with particular applicability for patients at low thromboembolic risk.

Keywords: NOAC; echocardiographic indices; left atrial appendage thrombus; predictors of left atrial thrombus; thromboembolic risk; transthoracic echocardiography.

Copyright © 2022 Kaufmann, Wabich, Kapłon-Cieślicka, Gawałko, Budnik, Uziębło-Życzkowska, Krzesiński, Starzyk, Wożakowska-Kapłon, Wójcik, Błaszczyk, Hiczkiewicz, Budzianowski, Mizia-Stec, Wybraniec, Kosmalska, Fijałkowski, Szymańska, Dłużniewski, Haberka, Kucio, Michalski, Kupczyńska, Tomaszuk-Kazberuk, Wilk-Śledziewska, Wachnicka-Truty, Koziński, Burchardt and Daniłowicz-Szymanowicz.